Tracking the progression of people and processes within the field of medicine has long been both my academic focus and a profound source of fascination and joy for me. Despite all this experience, it becomes far more difficult when the journey I must reflect upon this time is my own.
It may perhaps be best to start with the profound shift in my perception of medicine between the start of medical school and today. The best analogy for my emotional mind frame when applying and entering medical school is the thought process many people have about having a baby. A baby or rather the status of parent is largely viewed by society as an unmitigated good, the mere pursuit of the position often elicits praise from those around you and most crucially in a world and life that often feel empty you feel like having and doing this one great thing whether becoming a doctor or a parent will finally offer you enough meaning to truly feel as though you have value to the world and maybe even enough to allow you find a long-elusive sense of self-worth. Experience has not proven this mirroring of medicine and parenthood wholly wrong just in terms of different aspects. While I will fully admit that being admitted to medical school (or having a baby) will not instantly fix your life based on my limited experience with babies they, like medicine, do rob you of sleep, induce at times abysmal self-doubt and are far messier emotionally and physically than those unfamiliar with the practice think possible. At the same time though both also share the profound joy and honor to lose time and expend energy for the betterment of something you never imagined loving so much before it entered your life.
Proceeding logically from the deep emotional connection I have built to medicine I now wish to respond to the overall importance that emotion plays within medicine. Having trained in bioethics prior to medical school and understanding the gravity of certain aspects of medicine I was not blind to the fact that consideration and emotional awareness would be aspects in a life dedicated to caring for patients however the extent to which this is true has been striking. There is a surprising way in which emotional connection can at times supersede the stated reason for an encounter. My experience in PD 3, a week of immersion in the hospital, I believe reflected this the most as the standard history and physical questions expanded to encompass stories of one patient’s own journey’s to medical school in late middle age. He shared the pain of having to close his clinic and his heartfelt faith in the potential of a total stranger to navigate and improve the world he had been forced to leave because of ill health. While I could do nothing for this patient’s stage IV cancer for a brief period I allowed him to once again cross the boundary from patient to provider as he guided me through his own exam. These tangents can also bear invaluable clinical fruit. Returning to PD 3 having shared a conversation about another patient’s joy at overcoming his addiction, his goals for the future and his overall optimism motivated me to closely examine the patient’s chart and argue strongly against the fact that his in-hospital pain regimen was centered on opioid utilization. While I was ultimately unable to shape the patient’s care having him be very much a person allowed me to overcome my strong tendency to defer to authority and protocol and argue for a more individualized approach.
Strange as it may seem given the last two paragraphs and the genuine joy I receive from direct patient interaction but a further and perhaps most marked shift in the formation of my identity as a future physician has been the discovery of how much joy I find in Pathology a field with fairly limited patient contact. Having spent much of my life exposed to medicine both as the child of doctors and through academic interests, I entered first-year with a clear idea of what a doctor was and my own trajectory towards that vision. When certain challenges came along, Pathology became my light just as medical history did when I almost abandoned premed early in my undergraduate career. Through my experiences in pathology, I was able to regain an acceptance of my own suitability for medical school, reconstruct a relatively positive self-perception and crucially start to construct a unique niche for myself. Beyond that, I see in pathology many of the things that first drew me to medicine: the ability to teach, true lifelong learning, the continued ability to apply my strong communication skills and at least in the pathologists I have met, colleagues who genuinely value each other’s passions and uniqueness. None of this is to say that I will ultimately go into pathology, only that the last two years have taught me the value of a very different view of medicine especially for those of us who, as the UH Pathology residency director describes it, “do not always manifest our empathy conventionally.”
The last major shift has been in a better appreciation for the practice of acknowledging and accepting one’s limits. I have spent the last year leading two student organizations, conducting research, blogging and paramount of all attending to my responsibilities as a medical student it has become increasingly clear how precarious balance truly is. Intimately tied to this is the acceptance that less than ideal results do not imply a lack of effort or engagement. Crystallizing this is the language of the pass/fail curriculum in which rather than explicitly passing or failing we meet (or exceed expectations) or we do not meet expectations.
My first two years of medical school have been a period of enormous personal and academic growth. Through a number of challenges, the lessons working through them taught me and the successes this increased insight has allowed me I feel I have come closer to the thoughtful and pragmatic physician and individual I hope to be.